Management of Vascular Injuries to the Extremities after Trauma

Kim, Han Yong; Park, Jae Hong; Kim, Myoung Young; Hwang, Sang Won

Abstract

BACKGROUND: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. MATERIAL AND METHOD: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. RESULT: There were 38 men and 5 women patients with a mean age of 42.0+/-16.8 years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was 319.0+/-482.2 minutes (range: 27~2,400 minutes). The average time from admission to discharge was 53.1+/-56.0 days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively.
CONCLUSION
Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.